Estate & Elder News

A Note from Christine

Hi ~Contact.FirstName~,

Big changes are happening in the Medicare Program that also deal with estate planning!

Just recently, Medicare approved an initiative to pay local doctors to have conversations with their patients regarding their healthcare and end-of-life wishes.

Medicare is hoping this new “push” will get more people talking openly about the type of care they do, or do not want, in a medical crisis with their physicians.

The reasons are both practical and financial; many people go on to receive treatments that they would would NEVER want to at the end of their life because they failed to complete a Living Will or make their wishes known to their family.

By having such healthcare conversations in the doctor’s office, then, Medicare is hoping to cut back on unnecessary services, and also empower families to know that they will be able to do everything their loved one “would have wanted” during an illness, disability or incapacity.

Of course as an estate planning attorney, I’m excited about this initiative to get patients and their doctors talking and on the same page. However, it’s important to remember that doctors can not give legal advice, so taking the leap from making your wishes KNOWN to making them legally binding will still fall on the patient and his or her attorney to complete that last step.

I’ve included some important conversation starters in the feature article below to help you get these discussions flowing with your doctor. And, when you’re clear on your goals and wishes for medical, long-term or end-of-life care, call the office and we’ll schedule a time for you to come into complete legally binding Powers of Attorneys and Advanced Healthcare Directives.

Have a great month,




Medicare Wants You to Talk to Your Doctor About Medical and End-Of-Life Wishes

Medicare is hoping to encourage more patients to talk to their doctors about end-of-life preferences and wishes for medical care by now paying physicians to have these critical conversations during office visits.

In an effort to incentivize more physicians to have open conversations with their patients about medical and end-of-life wishes, Medicare will now pay doctors to talk about healthcare directives during office visits.

The logic behind the decision, according to Medicare, is simple; studies show that patients are more satisfied and receive better quality care when Advance Healthcare Directives that lay out a patient's wishes for care are available and legally in place.

A recent survey of emergency room physicians by Geneia confirms this idea, finding that:

  • Most emergency medicine physicians (93 percent) are less frustrated in cases where an advance directive is easily accessible.
  • Eighty-five percent of emergency medicine physicians agree, "When a patient says they have an advance directive, it helps me deliver better quality of patient care."
  • Nearly nine in 10 emergency medicine physicians believe family members are more satisfied with the medical care when patients' wishes are known and communicated in an advance directive.
  • More than half (54 percent) of emergency medicine physicians describe their reaction to learning a patient has an accessible advance directive in place as "relief."

The other factor, according to Medicare, is purely financial. End-of-life care is complicated and expensive.

Many people at the end of their life go on to endure treatment that they would likely not agree to, if given the choice. By documenting a person's true end-of-life wishes and setting out clear boundaries for when life-saving measures such as feeding tubes or ventilators are to stop, Medicare hopes to cut back on non-beneficial medical interventions in advanced illness.

It's important to remember that Advanced Healthcare Directives are actually legal documents and physicians are unable to give legal advice; but having conversations about medical and long-term care with a doctor is a great place to start in exploring end-of-life options and making your wishes known.

For example, if you are dealing with a specific illness (such as cancer), your doctor would be able to lay out the normal course of treatment that you could expect over the following months and years. If there is something you do not agree with, or do not want, this is a great time to begin drawing boundaries around your care with your doctor.

The issue of incapacity is another topic to bring up in the doctor's office. In addition to legally naming someone in a Healthcare Directive who can make decisions if you are unable to speak for yourself, your doctor may also want you to complete a HIPAA form to keep on file listing this person as well. This will help direct your doctor as to who he or she should (or should not) communicate with if something happens to you.

Additional medical and end-of-life wishes to explore with your doctor include:

  • Whom do you trust to make make medical decisions on your behalf?
  • How do you feel about feeding tubes, life support and other artificial life saving devices?
  • What about organ donation?
  • Is there any type of medical care you would NEVER want?
  • If you were permanently disabled or incapacitated, what things would contribute or take away from your "quality of life"? 

  • What are your thoughts on nursing home vs. in-home health care?

Under the new Medicare provisions, physicians will get paid in 30 minute increments for discussing these topics with their patients.

But, to ensure all the bases covered, be sure to take the final step to have Healthcare Directives and Powers of Attorneys created with the help of an attorney so you'll have the peace of mind knowing that the issues discussed with your doctor are properly documented and will be legally honored later.



Christine Recommends

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About Christine Brown

Christine BrownChristine received her bachelor's degree from U.C. Santa Barbara and is a 1992 graduate of the University of the Pacific, McGeorge School of Law. She is formerly a partner in the law firm of Popeney, Lebetsamer & Brown, LLP. In January 2002, she opened her own law firm which concentrates solely in the area of elder law. Her special emphasis is on Medi-Cal long-term care planning and the concerns of the elderly, while also applying her extensive experience in estate planning, trust administration, probate and conservatorships.

Christine is a member of the National Academy of Elder Law Attorneys (NAELA), the South Bay Bar Probate and Estate Planning Section, as well as other community organizations concerned with the needs of older adults. As an active member of her community and State Bar, Christine volunteers regularly at various Superior Court Probate Departments in assisting the public with legal issues. She works regularly with California Advocates for Nursing Home Reform ("CANHR") and the Los Angeles Caregiver Resource Center.

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